Revision Rhinoplasty

Q: Dr. Eppley, I am interested in a revision rhinoplasty. I am 7 mos post-op from a primary rhinoplasty and hoping to have a revision as soon as possible. I have heard great things about you and your practice. My surgeon did not correct the profile and make it straight as we had talked about. The objective was just to lower/ straighten the bridge and do minimal narrowing to the supra tip without touching the tip. The only difference I saw after the cast came off was that he may have narrowed the supra tip slightly. I couldn’t smile initially, but as I began to get more movement back I noticed a crease that looks like a mustache when I smile. I asked him if he released a muscle at the base of the nose and he said no. It was an open rhinoplasty though. 

I just visited another doctor who who saw me before the procedure as well. He was not very encouraging about whether the crease could be eliminated, and saw no difference in my before and after images besides 2 bony lumps where it was broken and not rasped at all. These were more obvious after my surgeon used steroid shots 3x (I don’t have pics of this.) We did not continue with the shots since since I didn’t want to thin the skin further. My surgeon didn’t know what could be causing the crease, but acknowledged the bony lumps as “irregularities which may eventually warp the nose.” He said “time will tell,” but would not comp any part of a secondary surgery even though there was no positive change to my profile. I’ve attached before and after pictures for your review.

I would very much appreciate any suggestions you may have. Thanks and hope to hear back soon!

A:Thank you for sending your pictures. I think it is very clear that you got no reduction at all in your dorsal line/hump…which seemed like it was the major point of the rhinoplasty. Not sure what was done in the surgery that did not make that happen. But that is irrelevant now and could definitely be done at any point.

As of your upper lip crease, an open rhinoplasty incision by itself does not cause that issue. Modifying the caudal septum with depressor muscle release can but that does not appear to have been done. (particularly since even the bridge was not lowered) How to improve that now is vexing since its origin is not really known.

Dr. Barry Eppley
Indianapolis, Indiana